Chiropractic Economics' Feb. 3 Webinar Q&A

NEWS RELEASE Experts answered your questions from Chiropractic Economics’ Feb. 3 Webinar titled “Rehabbing Patients — Keep it simple, effective, and low-cost!” Please check the Web site frequently for answers to upcoming Webinars.

Q. Is there a code for Exercise Demonstration?

A. There are a few codes that can be used, but check with you insurance provider representative to ensure the best code is being used. (Jan Greenstein, DC, CCSP)

Q. What is the name of the board used in the knee rehab?

A. I Joy Board. It is an external proprioceptive device. It’s also important to use an internal stability device like the Thera-Band stability pads. We use both in our practices. (Jan Greenstein, DC, CCSP)

A. iJoyBoard, contact Jeffrey Rawitch at jrawitch@gmail.com and tell him Greg or Tom sent you. The cost is $259 + shipping and any state tax in your state if you have state tax. They sell for over $450 generally. We get nothing for the sale of the iJoyBoard, just simply love it and found someone who will work with us to hold down costs to clinicians. They simply used this to stand on without exercise or treatment. In about 30 minutes, I showed them how to use it for rehab and treatment. We can do both upper and lower closed chain exercises, and even treat at the same time. For an example, you can have someone do a push up or a simply plank while treating. If you wish to make it more complicated and challenging, place the stability pads on the iJoy and have them do pushups while you treat or use the Perfect Pushup and place it on the iJoy and treat or place the Perfect Pushup on the stability pads on the iJoy and their feet on an exercise ball if you want to get more complex. The sky is the limit. You can stand and do exercises with weights, bands, flexbars, body blades, juggle, and on and on and on. (Tom Hyde, DC, DACBSP)

Q. Do you charge your patients for the DVD and take home therapy equipment? How do you “sell” them?

A. Yes I charge my patients. I don’t sell anything. I explain to the patient this is what they need, this is why I’m giving it to them, and this is how it’s going to save them time and money. It’s an investment in their health. (Jay Greenstein, DC, CCSP)

Q. What about a frozen shoulder? Mri superspinatus tendonitis. rom decreased in abduction?

A. These are great products to use for these conditions. Taking Dr. Hyde’s and Dr. Doerr’s courses, both Graston Technique and Faktr-pm are invaluable courses that can help you understand important rehab techniques. (Jan Greenstein, DC, CCSP)

Q. How do you get them to refer to DCs vs. physiotherapists?

A. We demonstrate superior expertise in our craft by having excellent patient outcomes and continual communication with referral sources. (Jan Greenstein, DC, CCSP)

A. Give them a demonstration of what you do. Take them to lunch/dinner and either treat them personally or treat a patient you have in common and let the patient work on your behalf. Invite them to your office to see it first hand and what you do and the fact that you look at fascia and soft tissue, not just rehabilitation of muscles. (Tom Hyde, DC, DACBSP)

Q. Where do you get wall posters, protocols, home exercise programs and sheets for office or home?

A. All of that comes with the Thera-Band systems. (Jay Greenstein, DC, CCSP)

Q. Was it therabandacademy.com?

A. www.thera-bandacademy.com (Jay Greenstein, DC, CCSP)

A. It offers free exercises, peer reviewed articles you can read directly online for many, many specific conditions, exercises you can copy and use in slide presentation, use for your patients and much more. There are also classes they provide you can attend like the Bands, Balls and Balance classes. Many people think they know how to use these simple products but how many know the color band and degree of stretch required to give you the equivalent to 5 lbs in weight? How many know how to accurately inflate an exercise ball, all the exercises one can do, how many know the Bruegger exercises and more? (Tom Hyde, DC, DACBSP)

Q. Have any of the doctors had an insurance company try to charge two co-payments on one visit if exercise/therapuetic codes are used?

A. No. (Jay Greenstein, DC, CCSP)

Q. Which rehab seminars are the most comprehensive in your opinion?

A. Check the Thera-Band Academy Web site for courses in your area. (Jay Greenstein, DC, CCSP)

A. Those dealing with work by Janda to me personally, Liebenson, some like Craig Morris, Pavel and others. (Tom Hyde, DC, DACBSP)

Q. I understand the need to have a versatile rehab system that is easy to use in office, but what happens when a patient is ready to start at home and can’t afford the $400-$800 systems? It appears they (the patients) would ne
ed a whole host of separate products to equal a whole system.

A. Thera-Band makes the rehab kits that range from approximately $30-$50. That’s for everything they need to get started and continue on a home exercise program. (Jay Greenstein, DC, CCSP)

A. I started by placing one shower curtain rod vertical and one horizontal, then attaching bands and tubes to each curtain rod. I could slide the bands/tubes up and down in any direction and use that as my work station. That is very inexpensive but you must caution your patients to anchor the rods into a solid wall before ever attaching bands, they absolutely MUST secure the rods appropriately. The stability pads are very inexpensive as are soft weights and many other low tech rehab items. You can do a lot of exercises with just a ball and bands with people of all ages and abilities. (Tom Hyde, DC, DACBSP)

Q. How do we organize an efficient and doctor monitored exercise outline and still be able to focus on a higher level of patient volume within the day’s regular schedule?

A. Plan ahead. Take time to plan your rehab protocols, implement processes that will allow for smooth transition to active care practice. Plan, implement, assess, improve ad infinitum. (Jay Greenstein, DC, CCSP)

A. More than 20 years ago, I hired an ATC who helped me and was tremendous. He was excellent at examinations, rehab, stretching and knew all the physical modalities. That alone saved me tons of time and cost not much more than just hiring someone off the street and also built inter-professional relationships. You can also hire a PT or PTA if your state laws allow you. If not, once you learn what to do, it will just flow and will not take that much time. A shoulder can be treated from 5 minutes up to 30, depending on what you have to do if you want to try to treat everything in one visit and if no, you simply divide up the treatment into blocks of time you can handle depending upon your overall schedule. I always tell DC’s to remember the first time they did a cervical adjustment, you worried about your position, your line of drive, contact point, patient position, amount of thrust, rotation, no rotation, etc, etc but now I bet you adjust family members in 2 seconds most of the time without even thinking of what you are doing and with a little time, the rehab, faktr-pm treatment will be just as easy and quick. (Tom Hyde, DC, DACBSP)

Q. What is 97150 CPT Code explanation?

A. Group exercise. Check CPT code book or chiro-code book for greater detail. (Jay Greenstein, DC, CCSP)

Q. Do you sell exercise protocol sheets?

A. No, it’s included in the Thera-Band rehab kits. (Jay Greenstein, DC, CCSP)

Q. Has any doctor used exercise prescription software like “Phases Rehab” to help develop their own protocols?

A. Yes, we like Thera-Band’s online programs. (Jay Greenstein, DC, CCSP)

A. I used Therapycise about 12-14 years ago which allowed me to customize each treatment I rendered. If I had an ACL to rehab, I simply could chose those exercises I wanted for that particular patient, add the number of reps and the company would create a video of a model actually performing that exercise while counting reps and explaining to the patient what to do. They had a great program but it failed, it was ahead of its time. I cannot answer about other programs, sorry. (Tom Hyde, DC, DACBSP)

Q. What’s a Bruegger exercise?

A. A postural exercise that fires extensor muscles. (Jay Greenstein, DC, CCSP)

Q. Does the panel see a benefit to e-stim and ultrasound?

A. Limited to acute stage or injury and/or utilization of Russian stim later in care. (Jay Greenstein, DC, CCSP)

A. I rarely used it but each person has his/her own beliefs about these modalities so I tend to let each clinician chose those modalities they think are best for each patient and their particular condition. (Tom Hyde, DC, DACBSP)

Q. Can staff supervise rehab and is procedure still billable? What if the doctor is not in the office?

A. You must check your state regulations and insurance company contracts if applicable. (Jay Greenstein, DC, CCSP)

Q. What is your success rate with grade 3 AC shoulder separation?

A. I CO treat with orthos on cases like these. That can have excellent outcomes. (Jay Greenstein, DC, CCSP)

Q. Would like to start simple rehab in my office. Insurance doesn’t reimburse. How much do you charge the patient for this service? Have any of you had any experience with using the rehab area as a “Gym” where patients can come and use the equipment for a set fee? How much to charge?

A. My fees are irrelevant. What do you think the value of the service is worth? Charge it. Using the “gym” on off times is an excellent way to generate revenues. (Jay Greenstein, DC, CCSP)

A. All I can give you is a range I hear from docs around the country and they range from $20 up with the most I have heard in Manhattan of $250. I do not know how long the treatment provided is nor exactly what they are doing for those fees, perhaps someone else might know. (Tom Hyde, DC, DACBSP)

Q. Would you find it useful to hire a certified athletic trainer in the chiropractic setting to help with rehab?

A. Absolutely, but check state/insurance regulations regarding billing for services they provide. (Jay Greenstein, DC, CCSP)

A. Without question, one of the very best things I ever did in practice, I personally would never, ever practice without an ATC or PT, PTA working with me. Why would someone hire someone off the street, a friend, someone from an ad who has no knowledge of the human body or very little, knows nothing about rehab, modality use, etc? Why not hire someone who knows all this and more and reduces your liability at the same time? (Tom Hyde, DC, DACBSP)

Q. Can you cover idiopathic coccyx pain?

A. The history is important, including current ergonomic demand as well as other non-musculoskeletal factors. Obviously look at anatomical/biomechanical potential pain procedures as well. (Jay Greenstein, DC, CCSP)

A. Sorry we did not get to this and here goes my shot at this. I love Graston Technique for this. You can use GT 4 to scan over the general area of the coccyx and over the coccyx. Then, take the hook of GT 6 and use it to treat specific areas of pain or tenderness on the external surface all around the coccyx. You can also KT the coccyx. (Tom Hyde, DC, DACBSP)

Q. When dealing with patients who have surgically fused vertebra such as C4-C5, C5-C6 with chronic pain and chronic frozen shoulder due to a MVA etc… How does this effect rehabilitation outcomes and procedures? Please include some pricing strategies.

A. Your goal is to maximize their level of function. Rehab should be an integral part of their care. Pricing is driven by both value delivered and market forces. (Jay Greenstein, DC, CCSP)

Q. We currently have a patient who had knee surgery 8 weeks ago. I want to make sure we are fully covering all treatments to help her rehab progress. I would be interested in hearing the current treatments.

A. A review of the current literature is the best place to start. There’s no substitute for doing your homework. (Jay Greenstein, DC, CCSP)

A. I personally had arthroscopic knee surgery about 4 years ago now. I was injured climbing in Brazil with my daughter when I slipped on skree. There was a very loud “pop”, instant pain and lots of swelling within 2 hours. My knee became very still and very, very painful to bend. I was in the middle of nowhere for an additional 7 days climbing. When I returned to the US, Warren Hammer examined me and treated me with some Graston Technique for pain control and edema reduction. That one t
reatment provided 70% relief and increases my ROM tremendously. I also was examined by an ortho and everyone seemed to think I had a torn meniscus due to lack of full extension and full flexions due to pain. After a year and a half of negative x-rays and MRI, I had a repeat MRI and both were normal. With a pop and quick edema, the first thought was ACL but that was strong, then next with the failure to have full ROM was meniscus but nothing showed on the films and MRI’s so I finally opted for exploratory arthroscopy. The surgeon found 3 chunks of articular cartilage from the distal femur in the joint. He cleaned that out on a Friday. On Monday, I began rehab and the PTs used GT on my iliotibial band and quad goup. I had 3 treatments with GT and exercises over 1.5 weeks and had pretty much full ROM and very minimal pain or discomfort. Four weeks post surgery, I was climbing in Yosemite with no pain or discomfort at all, therefore, try this approach or something similar. I also use KT to help with edema and for the neuro stimulation. (Tom Hyde, DC, DACBSP)

Q. Would like to know how to get started with implementing active care in my office in NJ and to find out which insurances reimburse for active care and how to document the necessity?

A. The best thing to do is speak to the source. Don’t ask you colleagues as they may not have al the facts. Sit down with each of you provider reps and discuss this with them. Further, be sure to check with your state regarding laws and scope of practice. (Jay Greenstein, DC, CCSP)

Q. Does Thera-Band give specific exercises and also frequency and repetition advice with their products?

A. Yes, go to www.thera-bandacademy.com. (Tom Hyde, DC, DACBSP)